De novo atrial fibrillation after mitral valve surgery

Christopher K. Mehta, Patrick M McCarthy*, Adin-Cristian Andrei, Jane Kruse, Hangzhi Shi, Andrei Churyla, S Chris Malaisrie, Duc Thinh Pham, James Lewis Cox

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: We sought to determine the incidence and risk factors for de novo atrial fibrillation (>90 days after surgery) in patients without preoperative atrial fibrillation. Methods: From 2004 to 2014, 2261 patients underwent mitral valve surgery; 1288 patients (57%) did not have a history of atrial fibrillation, and 930 patients had rhythm information more than 90 days after surgery. De novo atrial fibrillation and death probabilities were estimated using a semi-competing risks, multi-state model. Univariable and multivariable risk factors for developing atrial fibrillation were identified using the Fine–Gray model. Results: The 5- and 10-year incidences of de novo atrial fibrillation were 14% and 23%, respectively. Univariable risk factors were older age, more complex operations, more tricuspid regurgitation, and congestive heart failure (all P <.05). Patients with degenerative mitral regurgitation were less likely to develop atrial fibrillation (hazard ratio [HR], 0.4; 95% confidence interval [CI], 0.24-0.65; P <.001). Multivariable risk factors for de novo atrial fibrillation were tricuspid valve surgery (HR, 1.80; 95% CI, 1.22, 2.65; P =.003), aortic valve surgery (HR, 1.49; 95% CI, 1.03-2.17; P =.035), and older age (HR, 1.03; 95% CI, 1.02-1.05; P <.001). De novo atrial fibrillation did not affect overall survival (P =.41). Among patients who developed de novo atrial fibrillation, we observed increased use of warfarin (P <.001) and a strong trend toward an increased risk of stroke (P =.055). Conclusions: De novo atrial fibrillation develops progressively after mitral surgery and is associated with a strong trend toward stroke. Patients at high risk could be studied in a trial to reduce atrial fibrillation.

Original languageEnglish (US)
Pages (from-to)1515-1525.e11
JournalJournal of Thoracic and Cardiovascular Surgery
Volume156
Issue number4
DOIs
StatePublished - Oct 1 2018

Fingerprint

Mitral Valve
Atrial Fibrillation
Confidence Intervals
Ambulatory Surgical Procedures
Stroke
Tricuspid Valve Insufficiency
Tricuspid Valve
Incidence
Mitral Valve Insufficiency
Warfarin
Aortic Valve
Heart Failure

Keywords

  • mitral valve surgery
  • postoperative atrial fibrillation

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{7957d1edfb6145e097351409631a4607,
title = "De novo atrial fibrillation after mitral valve surgery",
abstract = "Objectives: We sought to determine the incidence and risk factors for de novo atrial fibrillation (>90 days after surgery) in patients without preoperative atrial fibrillation. Methods: From 2004 to 2014, 2261 patients underwent mitral valve surgery; 1288 patients (57{\%}) did not have a history of atrial fibrillation, and 930 patients had rhythm information more than 90 days after surgery. De novo atrial fibrillation and death probabilities were estimated using a semi-competing risks, multi-state model. Univariable and multivariable risk factors for developing atrial fibrillation were identified using the Fine–Gray model. Results: The 5- and 10-year incidences of de novo atrial fibrillation were 14{\%} and 23{\%}, respectively. Univariable risk factors were older age, more complex operations, more tricuspid regurgitation, and congestive heart failure (all P <.05). Patients with degenerative mitral regurgitation were less likely to develop atrial fibrillation (hazard ratio [HR], 0.4; 95{\%} confidence interval [CI], 0.24-0.65; P <.001). Multivariable risk factors for de novo atrial fibrillation were tricuspid valve surgery (HR, 1.80; 95{\%} CI, 1.22, 2.65; P =.003), aortic valve surgery (HR, 1.49; 95{\%} CI, 1.03-2.17; P =.035), and older age (HR, 1.03; 95{\%} CI, 1.02-1.05; P <.001). De novo atrial fibrillation did not affect overall survival (P =.41). Among patients who developed de novo atrial fibrillation, we observed increased use of warfarin (P <.001) and a strong trend toward an increased risk of stroke (P =.055). Conclusions: De novo atrial fibrillation develops progressively after mitral surgery and is associated with a strong trend toward stroke. Patients at high risk could be studied in a trial to reduce atrial fibrillation.",
keywords = "mitral valve surgery, postoperative atrial fibrillation",
author = "Mehta, {Christopher K.} and McCarthy, {Patrick M} and Adin-Cristian Andrei and Jane Kruse and Hangzhi Shi and Andrei Churyla and Malaisrie, {S Chris} and Pham, {Duc Thinh} and Cox, {James Lewis}",
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De novo atrial fibrillation after mitral valve surgery. / Mehta, Christopher K.; McCarthy, Patrick M; Andrei, Adin-Cristian; Kruse, Jane; Shi, Hangzhi; Churyla, Andrei; Malaisrie, S Chris; Pham, Duc Thinh; Cox, James Lewis.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 156, No. 4, 01.10.2018, p. 1515-1525.e11.

Research output: Contribution to journalArticle

TY - JOUR

T1 - De novo atrial fibrillation after mitral valve surgery

AU - Mehta, Christopher K.

AU - McCarthy, Patrick M

AU - Andrei, Adin-Cristian

AU - Kruse, Jane

AU - Shi, Hangzhi

AU - Churyla, Andrei

AU - Malaisrie, S Chris

AU - Pham, Duc Thinh

AU - Cox, James Lewis

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Objectives: We sought to determine the incidence and risk factors for de novo atrial fibrillation (>90 days after surgery) in patients without preoperative atrial fibrillation. Methods: From 2004 to 2014, 2261 patients underwent mitral valve surgery; 1288 patients (57%) did not have a history of atrial fibrillation, and 930 patients had rhythm information more than 90 days after surgery. De novo atrial fibrillation and death probabilities were estimated using a semi-competing risks, multi-state model. Univariable and multivariable risk factors for developing atrial fibrillation were identified using the Fine–Gray model. Results: The 5- and 10-year incidences of de novo atrial fibrillation were 14% and 23%, respectively. Univariable risk factors were older age, more complex operations, more tricuspid regurgitation, and congestive heart failure (all P <.05). Patients with degenerative mitral regurgitation were less likely to develop atrial fibrillation (hazard ratio [HR], 0.4; 95% confidence interval [CI], 0.24-0.65; P <.001). Multivariable risk factors for de novo atrial fibrillation were tricuspid valve surgery (HR, 1.80; 95% CI, 1.22, 2.65; P =.003), aortic valve surgery (HR, 1.49; 95% CI, 1.03-2.17; P =.035), and older age (HR, 1.03; 95% CI, 1.02-1.05; P <.001). De novo atrial fibrillation did not affect overall survival (P =.41). Among patients who developed de novo atrial fibrillation, we observed increased use of warfarin (P <.001) and a strong trend toward an increased risk of stroke (P =.055). Conclusions: De novo atrial fibrillation develops progressively after mitral surgery and is associated with a strong trend toward stroke. Patients at high risk could be studied in a trial to reduce atrial fibrillation.

AB - Objectives: We sought to determine the incidence and risk factors for de novo atrial fibrillation (>90 days after surgery) in patients without preoperative atrial fibrillation. Methods: From 2004 to 2014, 2261 patients underwent mitral valve surgery; 1288 patients (57%) did not have a history of atrial fibrillation, and 930 patients had rhythm information more than 90 days after surgery. De novo atrial fibrillation and death probabilities were estimated using a semi-competing risks, multi-state model. Univariable and multivariable risk factors for developing atrial fibrillation were identified using the Fine–Gray model. Results: The 5- and 10-year incidences of de novo atrial fibrillation were 14% and 23%, respectively. Univariable risk factors were older age, more complex operations, more tricuspid regurgitation, and congestive heart failure (all P <.05). Patients with degenerative mitral regurgitation were less likely to develop atrial fibrillation (hazard ratio [HR], 0.4; 95% confidence interval [CI], 0.24-0.65; P <.001). Multivariable risk factors for de novo atrial fibrillation were tricuspid valve surgery (HR, 1.80; 95% CI, 1.22, 2.65; P =.003), aortic valve surgery (HR, 1.49; 95% CI, 1.03-2.17; P =.035), and older age (HR, 1.03; 95% CI, 1.02-1.05; P <.001). De novo atrial fibrillation did not affect overall survival (P =.41). Among patients who developed de novo atrial fibrillation, we observed increased use of warfarin (P <.001) and a strong trend toward an increased risk of stroke (P =.055). Conclusions: De novo atrial fibrillation develops progressively after mitral surgery and is associated with a strong trend toward stroke. Patients at high risk could be studied in a trial to reduce atrial fibrillation.

KW - mitral valve surgery

KW - postoperative atrial fibrillation

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